Editorial comment
Infective endocarditis: Positron emission tomography/computed tomography in clinical practice
Endocardite infeciosa: TC-PET na prática clínica
Maria João Vidigal Ferreira
Faculdade de Medicina de Coimbra, Coimbra, Portugal
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LVT: Lisbon and Tagus Valley; R: reference group in the logistic regression models.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andreia Leite, Ausenda Machado, Sónia Pinto, Baltazar Nunes, Carlos Matias Dias" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Andreia" "apellidos" => "Leite" ] 1 => array:2 [ "nombre" => "Ausenda" "apellidos" => "Machado" ] 2 => array:2 [ "nombre" => "Sónia" "apellidos" => "Pinto" ] 3 => array:2 [ "nombre" => "Baltazar" "apellidos" => "Nunes" ] 4 => array:2 [ "nombre" => "Carlos" "apellidos" => "Matias Dias" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305013?idApp=UINPBA00004E" "url" => "/08702551/0000003800000008/v2_201912121502/S0870255119305013/v2_201912121502/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0870255119305001" "issn" => "08702551" "doi" => "10.1016/j.repc.2019.09.001" "estado" => "S300" "fechaPublicacion" => "2019-08-01" "aid" => "1429" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2019;38:573-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 424 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 289 "PDF" => 93 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Advantages and limitations of 18-fluoro-2-deoxy-<span class="elsevierStyleSmallCaps">d</span>-glucose positron emission tomography/computed tomography in the diagnosis of infective endocarditis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "573" "paginaFinal" => "580" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Valor acrescentado e limitações da tomografia por emissão de positrões 18-fluoro-2-deoxiglicose – tomografia computadorizada no diagnóstico de endocardite infecciosa" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1072 "Ancho" => 1674 "Tamanyo" => 153052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Infective endocarditis in the native mitral valve and bioprosthetic aortic valve in an 88-year-old male hospitalized due to persistent fever and blood cultures positive for <span class="elsevierStyleItalic">Streptococcus viridans</span>. Echocardiographic results show a vegetation on the native mitral valve and no alterations in the bioprosthetic aortic valve. <span class="elsevierStyleSup">18</span>F-FDG PET images show two positive uptake foci, in (A) the native mitral valve (SUV<span class="elsevierStyleInf">max</span> 7.5) and (B–D) the prosthetic aortic valve (SUV<span class="elsevierStyleInf">max</span> 5.1).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Estephany Abou Jokh Casas, Virginia Pubul Núñez, María del Carmen Pombo Pasín, Miguel Garrido Pumar, Maria Amparo Martinez, Charigan Abou Jokh Casas, Anxo Martinez de Alegria, Maria Jesús Domínguez, Alvaro Ruibal Morell" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Estephany" "apellidos" => "Abou Jokh Casas" ] 1 => array:2 [ "nombre" => "Virginia" "apellidos" => "Pubul Núñez" ] 2 => array:2 [ "nombre" => "María del Carmen" "apellidos" => "Pombo Pasín" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Garrido Pumar" ] 4 => array:2 [ "nombre" => "Maria Amparo" "apellidos" => "Martinez" ] 5 => array:2 [ "nombre" => "Charigan" "apellidos" => "Abou Jokh Casas" ] 6 => array:2 [ "nombre" => "Anxo" "apellidos" => "Martinez de Alegria" ] 7 => array:2 [ "nombre" => "Maria Jesús" "apellidos" => "Domínguez" ] 8 => array:2 [ "nombre" => "Alvaro" "apellidos" => "Ruibal Morell" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204919302430" "doi" => "10.1016/j.repce.2019.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919302430?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119305001?idApp=UINPBA00004E" "url" => "/08702551/0000003800000008/v2_201912121502/S0870255119305001/v2_201912121502/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Infective endocarditis: Positron emission tomography/computed tomography in clinical practice" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "581" "paginaFinal" => "582" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Maria João Vidigal Ferreira" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Maria João" "apellidos" => "Vidigal Ferreira" "email" => array:1 [ 0 => "mjvidigal19@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Faculdade de Medicina de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Endocardite infeciosa: TC-PET na prática clínica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infective endocarditis is still a clinical challenge due to its high mortality and difficult diagnosis. Since it was first described by Osler in 1885, the profile of the disease has changed dramatically.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,2</span></a> Nowadays, it tends to affect older patients with various comorbidities, and health-care-associated bacteremia is frequently implied in the pathophysiology of the disease.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3–5</span></a> Resistance to antibiotic therapy is a common problem in modern practice and a potential source of undesirable outcomes.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> Degenerative valve disease and cardiac prostheses and implanted devices are common risk factor conditions. Early diagnosis and aggressive treatment are required in order to prevent complications, but this is often difficult, as the clinical presentation is non-specific. The diagnosis is based on the modified Duke criteria, the cornerstones of which are microbiological analysis of blood cultures and echocardiographic evidence of endocardial involvement. Additional imaging may be necessary, especially when prosthetic valves or intracardiac devices are involved.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recent developments in nuclear medicine have widened the availability of hybrid imaging devices such as positron emission tomography (PET)/computed tomography (CT), in which the radiotracer signal is combined with an anatomic assessment by CT, improving image interpretation and clinical acceptance. <span class="elsevierStyleSup">18</span>F-fluoro-2-deoxyglucose (<span class="elsevierStyleSup">18</span>F-FDG) is a glucose analog radiotracer that has the highest uptake in regions of high metabolism, such as those with activated leukocytes.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">7,8</span></a> It has several advantages, including high sensitivity for hypermetabolic activity, high spatial resolution and the ability to detect peripheral events. The use of <span class="elsevierStyleSup">18</span>F-FDG PET/CT in infective endocarditis has been incorporated in the latest European Society of Cardiology guidelines for the management of infective endocarditis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The study by Casas et al. published in this issue of the <span class="elsevierStyleItalic">Journal</span> prospectively assessed 43 patients with suspected infective endocarditis by transesophageal echocardiography and <span class="elsevierStyleSup">18</span>F-FDG PET/CT.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> The diagnosis was confirmed, using the modified Duke criteria, in 30 patients and overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 80%, 92%, 96% and 66% for PET/CT and 36%, 94%, 94% and 36% for echocardiography, respectively. Of the 43 patients, 19 had prosthetic valves and seven had intracardiac devices. The results indicate that PET/CT had a better diagnostic performance in the latter group, with sensitivity of 91% and specificity of 85% compared with echocardiography, which presented sensitivity of 25% and specificity of 100%. In patients with infective endocarditis of native valves, echocardiography was superior to PET/CT, with sensitivity and specificity of 83% and 66% vs. 33% and 100%, respectively.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">These results are similar to those of other studies in which PET/CT combined with the modified Duke criteria or with echocardiography showed higher diagnostic accuracy, especially in patients with prosthetic valves. A large prospective study of 303 episodes of suspected endocarditis, in 188 prosthetic valves and 115 native valves, found sensitivity, specificity, PPV and NPV of 93%, 90%, 89% and 94%, respectively, when PET/CT was combined with the Duke criteria on admission in patients with prosthetic valves and 22%, 100%, 100%, and 66%, respectively, in patients with native valves.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> There are several possible explanations for the lower sensitivity of PET/CT in native valves, including low level of metabolism, vegetation size, heart movement and background tracer uptake.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> In a multicenter study, Swart et al. found improved sensitivity for prosthetic valve endocarditis (100%) when semi-quantitative methods for tracer uptake were applied.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnostic accuracy of PET/CT for prosthetic valves is such that a positive exam before structural damage occurs could help prevent complications.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The indications for cardiac implantable electronic devices continue to grow, encompassing heart failure, bradyarrhythmias and tachyarrhythmias. However, infections associated with these devices carry a significant risk of morbidity and mortality. Early diagnosis can prevent complications, including avoiding the need to remove the device. <span class="elsevierStyleSup">18</span>F-FDG PET/CT is able to identify foci of cardiac and extracardiac infection. In a meta-analysis of 14 studies, PET/CT had pooled sensitivity and specificity of 96% and 97% for identification of pocket infection, and 76% and 83% for lead infection, respectively.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite the advantages of this imaging technique, it is also known to have several limitations, including high costs and limited availability, radiation exposure and lack of standardized protocols.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,2</span></a> In Portugal, PET/CT equipment is usually found in large-volume nuclear medicine departments, where its major application is in oncology, and the ability to perform cardiology exams is limited. There is a need for standardization across centers regarding threshold values of tracer uptake and protocols for patient preparation. The lower specificity of PET/CT in patients with recently implanted prosthetic valves, due to procedure-related inflammation, should also be noted.</p><p id="par0040" class="elsevierStylePara elsevierViewall">To overcome the limitations of PET/CT and take advantage of its potential, it is crucial to recognize the importance of a multidisciplinary approach with a dedicated team in which clinicians and imaging specialists pool their knowledge to select the most appropriate diagnostic and risk stratification tools, in order to improve therapeutic guidance and patient outcome.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The changing face of infective endocarditis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.D. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 5 | 12 |
| 2024 Outubro | 40 | 33 | 73 |
| 2024 Setembro | 31 | 20 | 51 |
| 2024 Agosto | 47 | 29 | 76 |
| 2024 Julho | 41 | 33 | 74 |
| 2024 Junho | 39 | 14 | 53 |
| 2024 Maio | 26 | 15 | 41 |
| 2024 Abril | 48 | 34 | 82 |
| 2024 Maro | 46 | 20 | 66 |
| 2024 Fevereiro | 24 | 15 | 39 |
| 2024 Janeiro | 51 | 24 | 75 |
| 2023 Dezembro | 21 | 26 | 47 |
| 2023 Novembro | 22 | 25 | 47 |
| 2023 Outubro | 11 | 19 | 30 |
| 2023 Setembro | 28 | 18 | 46 |
| 2023 Agosto | 18 | 20 | 38 |
| 2023 Julho | 22 | 9 | 31 |
| 2023 Junho | 36 | 19 | 55 |
| 2023 Maio | 33 | 29 | 62 |
| 2023 Abril | 17 | 3 | 20 |
| 2023 Maro | 39 | 25 | 64 |
| 2023 Fevereiro | 17 | 17 | 34 |
| 2023 Janeiro | 13 | 16 | 29 |
| 2022 Dezembro | 33 | 21 | 54 |
| 2022 Novembro | 27 | 27 | 54 |
| 2022 Outubro | 59 | 25 | 84 |
| 2022 Setembro | 22 | 44 | 66 |
| 2022 Agosto | 26 | 30 | 56 |
| 2022 Julho | 31 | 40 | 71 |
| 2022 Junho | 15 | 24 | 39 |
| 2022 Maio | 21 | 38 | 59 |
| 2022 Abril | 35 | 36 | 71 |
| 2022 Maro | 25 | 44 | 69 |
| 2022 Fevereiro | 23 | 34 | 57 |
| 2022 Janeiro | 19 | 21 | 40 |
| 2021 Dezembro | 17 | 21 | 38 |
| 2021 Novembro | 28 | 37 | 65 |
| 2021 Outubro | 23 | 44 | 67 |
| 2021 Setembro | 22 | 34 | 56 |
| 2021 Agosto | 32 | 30 | 62 |
| 2021 Julho | 6 | 17 | 23 |
| 2021 Junho | 15 | 26 | 41 |
| 2021 Maio | 39 | 24 | 63 |
| 2021 Abril | 36 | 17 | 53 |
| 2021 Maro | 25 | 25 | 50 |
| 2021 Fevereiro | 34 | 14 | 48 |
| 2021 Janeiro | 30 | 11 | 41 |
| 2020 Dezembro | 16 | 11 | 27 |
| 2020 Novembro | 18 | 17 | 35 |
| 2020 Outubro | 19 | 20 | 39 |
| 2020 Setembro | 14 | 8 | 22 |
| 2020 Agosto | 31 | 7 | 38 |
| 2020 Julho | 19 | 10 | 29 |
| 2020 Junho | 19 | 10 | 29 |
| 2020 Maio | 16 | 5 | 21 |
| 2020 Abril | 23 | 11 | 34 |
| 2020 Maro | 21 | 17 | 38 |
| 2020 Fevereiro | 88 | 67 | 155 |
| 2020 Janeiro | 41 | 13 | 54 |
| 2019 Dezembro | 96 | 31 | 127 |
| 2019 Novembro | 42 | 25 | 67 |
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